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Mifepristone pretreatment followed by misoprostol 200mcg buccal for the medical management of intrauterine fetal death at 14-28 weeks: A randomized, placebo-controlled, double blind trial

Fetal death may be managed surgically with dilatation and evacuation (D&E) or medical induction. However, surgery is often expensive in some settings and more difficult for more advanced pregnancies. Medical induction can be provided at a lower level facility by mid-level providers and in settings where surgical evacuation techniques are not available. The primary goal of this study was to determine whether mifepristone-misoprostol or placebo-misoprostol would result in a higher rate of complete expulsion of the fetus and the placenta within 48 hours of the start of misoprostol administration without any additional surgical intervention or medication (e.g. additional misoprostol doses or oxytocin).

Mifepristone-misoprostol did not result in a higher rate of complete expulsion of the fetus and the placenta within 48 hours of the start of misoprostol administration without any additional surgical intervention or medication than placebo-misoprostol. However, pretreatment with mifepristone followed by misoprostol bucally resulted in a shorter treatment time for medical management of fetal death than treatment with misoprostol alone. Pre-treatment with mifepristone may be more acceptable to women and providers by both reducing the length of hospital stay and the amount of misoprostol required.